Uterus and uterine tubes

Question 1

what is the muscular body of the uterus called?

Answer 1

the myometrium

Question 2

effect of maternal steroids?

Answer 2

increase the size of new-born uterus

Question 3

oestrogen causes an increase in?

Answer 3

endometrium and myometrium size

Question 4

what is the perimetrium?

Answer 4

on the outside

Question 5

what originate from the myometrium layer?

Answer 5

uterine fibroids

Question 6

what is the structure of the myometrium?

Answer 6

Inner layer - circular fibres
Middle layer - spiral fibres
Outer layer - longitudinal fibres

Question 7

when does the outer muscular myometrium grow?

Answer 7

grows gradually throughout childhood

• increases rapidly in size and configuration during puberty
• changes in size through the cycle

Question 8

what is the myometrium capable of?

Answer 8

vast expansion during pregnancy

Question 9

what is renewed every month?

Answer 9

the endometrium

• most of it is lost in menstruation
• it responds to oestrogen and progesterone

Question 10

what is the endometrium like in childhood?

Answer 10

very thin in childhood, and begins to thicken at puberty

Question 11

what is left of the endometrium after menstruation

Answer 11

stromal matrix
(smallest the endometrium can get)
-small columnar cells with glandular extensions 2-3mm thick

Question 12

what grows from the stromal matrix in response to oestrogen in the follicular phase?

Answer 12

endometrial layer

Question 13

the CL produces progesterone to….

Answer 13

……maintain endometrium thickness

Question 14

after ovulation what happens to the arteries

Answer 14

the arteries become more spiralled

-large SA which delivers a lot of blood and oxygen to the endometrium

Question 15

no pregnancy means what?

Answer 15

CL dies, progesterone levels fall and the endometrium sheds

Question 16

how is the endometrium made ready for embryo implantation?

Answer 16

-glands proliferate
-adhesion molecules and mucus secreted
this makes the surface receptive and sticky, ready for embryo implantation

Question 17

endometrial proliferative phase

Answer 17

• stimulated by oestrogen production from dominant follicle
• stromal cell division
• glands expand, become tortuous
• increased vascularity, neoangiogenesis

Question 18

in the proliferative phase, what happens when the endometrium >4mm?

Answer 18

• progesterone receptors start to get expressed on the endometrium, ready for the second half of the cycle
• small muscular contractions of the myometrium

Question 19

endometrial secretory phase

Answer 19

• 2-3 days after ovulation
• gradual rise in progesterone causes a reduction in cell division
• increase in tortuosity of glands
• secretion of glycoproteins and lipids
• arterioles contract and grow tightly wound
• myometrial cells enlarge and movement is suppressed
• blood supply increases, makes endometrium very receptive

Question 20

regression of the corpus luteum

Answer 20

• CL stimulated by LH from pit in luteal phase
• no pregnancy, no beta-HCG
• CL dies, no progesterone production
• endometrium sheds, menstruation

Question 21

how is the CL saved?

Answer 21

-fertilised oocyte becomes a blastocyst and produces human chorionic gonadotrophin (beta hCG) which acts like LH ie on LH receptor, and ‘rescues’ the CL

Question 22

what are pregnancy tests based on?

Answer 22

beta-HCG levels

Question 23

what happens in menstruation?

Answer 23

• endometrium releases prostaglandins, which constrict the spinal arterioles
• hypoxia causes necrosis
• vessels dilate, bleeding occurs
• proteolytic enzymes released from dying tissue, further tissue degradation
• basal layer remains, covered by extension of glandular epithelium

Question 24

how much of the endometrium is lost in he first 24 hrs of menstruation?

Answer 24

50%

Question 25

where does the embryo spend the first 5-6 days and how does it move?

Answer 25

the uterine tube | -moves along tube via peristalsis and cilia

Question 26

3 cell types in the uterine tube?

Answer 26

ciliated non ciliated secretory

Question 27

when is the only time the oocyte can move along the uterine tube and why?

Answer 27

mid cycle, in the ovulation period - oestrogen causes cilia to waft - activation of secretory cells - muscle layer contractions

Question 28

what happens in uterine tube before ovulation?

Answer 28

epithelial cells express estrogen receptors and differentiate in response to estradiol -increase in height mid-cycle

Question 29

what happens in uterine tube after ovulation?

Answer 29

a few days of exposure to progesterone means the estrogen receptors are supressed -estrogen effects are overcome causing decrease in epithelial cell height mid-luteal onward

Question 30

where does fertilisation occur?

Answer 30

the ampulla

Question 31

damage to uterine tube lining can cause?

Answer 31

pain infertility ectopic pregnancy - embryo doesn’t leave the tube

Question 32

name an infection that can block the uterine tube?

Answer 32

chlamydia

Question 33

what is tubal patency?

Answer 33

when a women's fallopian tubes are not blocked

Question 34

what can tubal potency be demonstrated by?

Answer 34

1. laparoscopy and dye - small incision made in the anterior wall, laproscope put through - a light on the end, gives a view inside the abdomen - air is pumped in so you can see - uterine cannula passed through the cervix, blue dye is injected into the uterus - expect the uterus to fill up with dye, dye will travel down the uterine tubes, emerging at the fimbrial end near the opening of the uterine tubes 2. Hystero Salpingo-contrast Sonography - less invasive - put cannula through cervix, inject opaque dye that reflects ultrasound - ultrasound probe put on the abdomen, monitor progress of dye without entering the abdomen

Question 35

why would laparoscopy and dye be used?

Answer 35

in cases of endometriosis - visualise

Question 36

what is endometriosis?

Answer 36

when a cell in the endometrium escapes from the uterus and gets into the pelvis or somewhere else, and implants -still responds to oestrogen and progesterone the same way they would if they were in the uterus (proliferate, differentiate, then shed)

Question 37

what is the cervix?

Answer 37

a muscular structure capable of great expansion

Question 38

endocervical mucosa?

Answer 38

mucosal lining of the cervix 3mm thick, lined with a single layer of columnar mucous cells which contains tubular mucous glands which empty viscous alkaline mucus into the lumen -protective barrier to infection -however has to allow passage of motile sperm

Question 39

what is the cervical mucus like?

Answer 39

-very viscous and stiff, blocks the cervix and prevents bacteria from entering -also impenetrable to sperm BUT during ovulation cervical mucus becomes less viscous, sperm can enter

Question 40

how does oestrogen affect cervical mucus?

Answer 40

- early phase of the cycle glycoproteins form a mesh barrier that sperm can’t get through - becomes less viscous - change in mucous composition - glycoproteins align, form microscopic channels which sperm swim up

Question 41

what does progesterone in the luteal phase cause?

Answer 41

- viscous mucous (reduced water content) - Glycoproteins form mesh structure, acts as barrier - One mechanism of action of oral contraceptives.

Question 42

vagina

Answer 42

- thick walled tube lined with squamous epithelium cells - warm damp environment containing glycoproteins - susceptible to infection

Question 43

bartholins glands

Answer 43

located slightly posterior, to the left and right of the opening of the vagina - secrete mucus to lubricate vagina - homologous to bulbourethral glands in males.